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Howley L, Eyerly-Webb S, Killen SAS, Paul E, Krishnan A, Gropler MRF, Drewes B, Dion E, Lund A, Buyon JP, Cuneo BF. Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies. J Matern Fetal Neonatal Med 2024; 37:2323623. [PMID: 38443062 PMCID: PMC11005667 DOI: 10.1080/14767058.2024.2323623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies. STUDY DESIGN An electronic REDCap questionnaire was distributed to Fetal Heart Society and North American Fetal Therapy Network members which queried institution-based risk stratification, surveillance methods/frequency, conduction abnormality treatments, and postnatal anti-SSA/Ro pregnancy assessment. RESULTS 101 responses from 59 centers (59% US, 17% international) were collected. Most (79%) do not risk stratify pregnancies by anti-SSA/Ro titer; those that do use varied cutoff values. Many pregnant rheumatology patients are monitored for cardiac abnormalities regardless of maternal anti-SSA/Ro status. Surveillance strategies were based on maternal factors (anti-SSA/Ro status 85%, titer 25%, prior affected child 79%) and monitoring durations varied. Most respondents treat 2° and 3° fetal atrioventricular block, commonly with dexamethasone and/or IVIG. CONCLUSIONS Wide variation exists in current fetal cardiac surveillance and treatment for anti-SSA/Ro autoantibody positive pregnancies, highlighting the need for evidence-based protocols to optimize care.
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Affiliation(s)
- Lisa Howley
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | | | - Stacy A. S. Killen
- Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA
| | - Erin Paul
- Icahn School of Medicine, Mount Sinai Children’s Heart Center, New York, NY, USA
| | | | | | - Bailey Drewes
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric Dion
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
| | - Amy Lund
- Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, MN, USA
- The Children’s Heart Clinic, Children’s Minnesota, Minneapolis, MN USA
| | - Jill P. Buyon
- New York University Grossman School of Medicine, NYU Langone Medical Center, New York, NY, USA
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Dunn Navarra AM, Gormley M, Liang E, Loughran C, Vorderstrasse A, Garcia DR, Rosenberg MG, Fletcher J, Goldsamt LA. Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV. PEC INNOVATION 2024; 4:100263. [PMID: 38463238 PMCID: PMC10920727 DOI: 10.1016/j.pecinn.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
Objective Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.
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Affiliation(s)
- Ann-Margaret Dunn Navarra
- StonyBrook University, School of Nursing, 101 Nicolls Road, Health Sciences Center, Level 2, StonyBrook, NY 11794, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269, USA
| | - Eva Liang
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Claire Loughran
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Allison Vorderstrasse
- University of Massachusetts Amherst, Elaine Marieb College of Nursing, 651 N Pleasant St., Amherst, MA 01003, USA
| | - David R. Garcia
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Michael G. Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, 10461, USA
| | - Jason Fletcher
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Lloyd A. Goldsamt
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
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Hertz S, Anderson JM, Nielsen HL, Schachtschneider C, McCauley KE, Özçam M, Larsen L, Lynch SV, Nielsen H. Fecal microbiota is associated with extraintestinal manifestations in inflammatory bowel disease. Ann Med 2024; 56:2338244. [PMID: 38648495 PMCID: PMC11036898 DOI: 10.1080/07853890.2024.2338244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/17/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION A large proportion of patients with inflammatory bowel disease (IBD) experience IBD-related inflammatory conditions outside of the gastrointestinal tract, termed extraintestinal manifestations (EIMs) which further decreases quality of life and, in extreme cases, can be life threatening. The pathogenesis of EIMs remains unknown, and although gut microbiota alterations are a well-known characteristic of patients with IBD, its relationship with EIMs remains sparsely investigated. This study aimed to compare the gut microbiota of patients with IBD with and without EIMs. METHODS A total of 131 Danish patients with IBD were included in the study, of whom 86 had a history of EIMs (IBD-EIM) and 45 did not (IBD-C). Stool samples underwent 16S rRNA sequencing. Amplicon sequence variants (ASVs) were mapped to the Silva database. Diversity indices and distance matrices were compared between IBD-EIM and IBD-C. Differentially abundant ASVs were identified using a custom multiple model statistical analysis approach, and modules of co-associated bacteria were identified using sparse correlations for compositional data (SparCC) and related to patient EIM status. RESULTS Patients with IBD and EIMs exhibited increased disease activity, body mass index, increased fecal calprotectin levels and circulating monocytes and neutrophils. Microbiologically, IBD-EIM exhibited lower fecal microbial diversity than IBD-C (Mann-Whitney's test, p = .01) and distinct fecal microbiota composition (permutational multivariate analysis of variance; weighted UniFrac, R2 = 0.018, p = .01). A total of 26 ASVs exhibited differential relative abundances between IBD-EIM and IBD-C, including decreased Agathobacter and Blautia and increased Eggerthella lenta in the IBD-EIM group. SparCC analysis identified 27 bacterial co-association modules, three of which were negatively related to EIM (logistic regression, p < .05) and included important health-associated bacteria, such as Agathobacter and Faecalibacterium. CONCLUSIONS The fecal microbiota in IBD patients with EIMs is distinct from that in IBD patients without EIM and could be important for EIM pathogenesis.
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Affiliation(s)
- Sandra Hertz
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Jacqueline Moltzau Anderson
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Hans Linde Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claire Schachtschneider
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn E. McCauley
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Mustafa Özçam
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Lone Larsen
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Aalborg University, Aalborg, Denmark
| | - Susan V. Lynch
- Department of Medicine, Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Janssens WH, Van Den Noortgate NJ, Mouton V, Desmet P, Van Puyvelde K, Steen E, Maere C, Van Mulders K, De Raes E, Dekoninck J, Kympers C, Werbrouck B, Delaere J, Piers RD. Opioids in geriatric units in 14 Belgian hospitals: prevalence, dosage and associated factors. Ann Med 2024; 56:2310132. [PMID: 38294956 PMCID: PMC10833115 DOI: 10.1080/07853890.2024.2310132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction: Adverse effects of opioids are common among older individuals, and undertreatment as well as overuse can be an issue. Epidemiological data on opioid use in older individuals are available, but scarce in hospitalized patients.Aims: The aim of this study is to examine the one-day prevalence of opioid use among older inpatients and identify the factors associated with both opioid use and dosage.Materials and methods: One-day cross-sectional study with data collected from geriatric units across 14 Belgian hospitals. The primary focus of the study is to assess the prevalence of opioid use and dosage, along with identifying associated factors. To achieve this, a multiple binary logistic regression model was fitted for opioid use, and a multiple linear regression model for opioid dose.Results: Opioids were used in 24.4% of 784 patients, of which 57.9% was treated with tramadol, 13.2% with oxycodone or morphine and 28.9% with transdermal buprenorphine or fentanyl. The odds for opioid use were 4.2 times higher in patients in orthogeriatric units compared to other patients (OR=4.2, 95% CI=2.50-7.05). The prevalence of opioid use was 34% higher in patients without dementia compared to patients with dementia (OR=0.66, 95% CI=0.46-0.95). The overall mean daily dosage was 14.07mg subcutaneous morphine equivalent. After adjustment for age, gender and dementia, dosage was only associated with type of opioid: the estimated mean opioid dose was 70% lower with tramadol (mean ratio=0,30,95% CI=0,23-0,39) and 67% lower with oxycodone and morphine (mean ratio=0,33, 95% CI=0,22-0,48) compared to transdermal buprenorphine and transdermal fentanyl.Conclusions: One in four patients received opioid treatment. It is not clear whether this reflects under- or overtreatment, but these results can serve as a benchmark for geriatric units to guide future pain management practices. The utilization of transdermal fentanyl and buprenorphine, resulting in higher doses of morphine equivalent, poses significant risks for side effects.
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Affiliation(s)
- Wim Henri Janssens
- Department of Geriatrics, University Hospital Ghent, Ghent, Belgium
- Department of Geriatrics, AZ Oudenaarde, Oudenaarde, Belgium
| | | | - Veerle Mouton
- Department of Geriatrics, AZ Groeninge, Kortrijk, Belgium
| | - Peter Desmet
- Department of Geriatrics, VITAZ, Sint-Niklaas, Belgium
| | | | - Elke Steen
- Department of Geriatrics, AZ Sint-Lucas Gent, Ghent, Belgium
| | - Caroline Maere
- Department of Geriatrics, AZ Sint-Lucas Brugge, Bruges, Belgium
| | | | | | | | | | - Bart Werbrouck
- Department of Geriatrics, AZ Jan Yperman, Ypres, Belgium
| | | | - Ruth D. Piers
- Department of Geriatrics, University Hospital Ghent, Ghent, Belgium
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Bybee SG, Eaton J, Wong B. Dissemination innovation: Using found poetry to return study results to patients and partners facing cancer. PEC INNOVATION 2024; 4:100286. [PMID: 38770044 PMCID: PMC11103570 DOI: 10.1016/j.pecinn.2024.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
Objective Investigators should return study results to patients and families facing cancer to honor their research contributions. We created a found poem from transcripts of sexual and gender minority (SGM) couples facing cancer and returned it to study participants. Methods Participants were randomized to receive the found poem in text, text and audio, audio, or video format, completed dissemination preferences and emotion questionnaires, and open-ended questions about their experience receiving the poem. Results Participants preferred the format they received (n = 15, 75.0%), with text-only and combined text and audio formats evoking the greatest number of emotions (n = 13 each). The following categories and subcategories were identified: dyadic experiences (support, strength, depth, durability); dissemination preferences (timing, method); emotion (positive, negative); utility of the found poem (affirming; fostering reflection; not useful or inaccurate, and sense of community). SGM participants utilized positive emotion, affirming, and a sense of community with greater frequency than non-SGM participants. Conclusion Innovative approaches to dissemination are acceptable; providing choices in how and when participants receive results may increase engagement; and SGM versus non-SGM groups may describe dyadic experiences differently. Innovation Returning study results via found poetry is an innovative way to honor research participants facing cancer.
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Affiliation(s)
- Sara G. Bybee
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Jacqueline Eaton
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
| | - Bob Wong
- University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112, United States of America
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Giraldo A, Shah P, Zerbo E, Nyaku AN. The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study. Ann Med 2024; 56:2355566. [PMID: 38823420 PMCID: PMC11146239 DOI: 10.1080/07853890.2024.2355566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities are evident in the accessibility of treatment for opioid use disorder (OUD). Even when medications for OUD (MOUD) are accessible, racially and ethnically minoritized groups have higher attrition rates from treatment. Existing literature has primarily identified the specific racial and ethnic groups affected by these disparities, but has not thoroughly examined interventions to address this gap. Recovery peer navigators (RPNs) have been shown to improve access and overall retention on MOUD. PATIENTS AND METHODS In this retrospective cohort study, we evaluate the role of RPNs on patient retention in clinical care at an outpatient program in a racially and ethnically diverse urban community. Charts were reviewed of new patients seen from January 1, 2019 through December 31, 2019. Sociodemographic and clinical visit data, including which providers and services were utilized, were collected, and the primary outcome of interest was continuous retention in care. Bivariate analysis was done to test for statistically significant associations between variables by racial/ethnic group and continuous retention in care using Student's t-test or Pearson's chi-square test. Variables with p value ≤0.10 were included in a multivariable regression model. RESULTS A total of 131 new patients were included in the study. RPNs improved continuous retention in all-group analysis (27.6% pre-RPN compared to 80.2% post-RPN). Improvements in continuous retention were observed in all racial/ethnic subgroups but were statistically significant in the non-Hispanic Black (NHB) group (p < 0.001). Among NHB, increases in continuous retention were observed post-RPN in patients with male sex (p < 0.001), public health insurance (p < 0.001), additional substance use (p < 0.001), medical comorbidities (p < 0.001), psychiatric comorbidities (p = 0.001), and unstable housing (p = 0.005). Multivariate logistic regression demonstrated that patients who lacked insurance had lower odds of continuous retention compared to patients with public insurance (aOR = 0.17, 95% CI 0.039-0.70, p = 0.015). CONCLUSIONS RPNs can improve clinical retention for patients with OUD, particularly for individuals experiencing several sociodemographic and clinical factors that are typically correlated with discontinuation of care.
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Affiliation(s)
- Arley Giraldo
- Department of Psychiatry, NYU Grossman School of Medicine, NYC, NY, USA
| | - Payal Shah
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erin Zerbo
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Independent Private Practice, Montclair, NJ, USA
| | - Amesika N. Nyaku
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Grossen SC, Arbuckle AL, Bihun EC, Koller JM, Song DY, Reiersen AM, Schlaggar BL, Greene DJ, Black KJ. We've all been wrong about provisional tic disorder. Compr Psychiatry 2024; 134:152510. [PMID: 38941871 DOI: 10.1016/j.comppsych.2024.152510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Provisional Tic Disorder (PTD) is common in childhood. The received wisdom among clinicians is that PTD is short-lived and mild, with at most a few tics, and rarely includes complex tics, premonitory phenomena or comorbid illnesses. However, such conclusions come from clinical experience, with biased ascertainment and limited follow-up. METHODS Prospective study of 89 children with tics starting 0-9 months ago (median 4 months), fewer than half from clinical sources. Follow-up at 12 (± 24, 36, 48) months after the first tic. RESULTS At study entry, many children had ADHD (39), an anxiety disorder (27), OCD (9) or enuresis (17). All had at least two current tics, with a mean total since onset of 6.9 motor and 2.0 phonic tics. Forty-one had experienced a complex tic, and 69 could suppress some tics. Tics were clinically meaningful: 64 had tics severe enough for a clinical trial, and 76 families sought medical attention for the tics. At 12 months, 79 returned, and 78 still had tics. Of these, 29 manifested no tics during history and extended examination, but only via audio-visual monitoring when the child was seated alone. Only 12/70 now had plans to see a doctor for tics. Most who returned at 2-4 years still had tics known to the child and family, but medical impact was low. CONCLUSIONS Our results do not contradict previous data, but overturn clinical lore. The data strongly argue against the longstanding but arbitrary tradition of separating tic disorders into recent-onset versus chronic.
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Affiliation(s)
- Sarah C Grossen
- Departments of Psychiatry and Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Amanda L Arbuckle
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Emily C Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Jonathan M Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - David Y Song
- Departments of Psychiatry and Neurology, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Angela M Reiersen
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, and Departments of Neurology and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, United States of America
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, United States of America.
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Wolf J, Chemudupati T, Kumar A, Franco JA, Montague AA, Lin CC, Lee WS, Fisher AC, Goldberg JL, Mruthyunjaya P, Chang RT, Mahajan VB. Using Electronic Health Record Data to Determine the Safety of Aqueous Humor Liquid Biopsies for Molecular Analyses. OPHTHALMOLOGY SCIENCE 2024; 4:100517. [PMID: 38881613 PMCID: PMC11179400 DOI: 10.1016/j.xops.2024.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 06/18/2024]
Abstract
Purpose Knowing the surgical safety of anterior chamber liquid biopsies will support the increased use of proteomics and other molecular analyses to better understand disease mechanisms and therapeutic responses in patients and clinical trials. Manual review of operative notes from different surgeons and procedures in electronic health records (EHRs) is cumbersome, but free-text software tools could facilitate efficient searches. Design Retrospective case series. Participants A total of 1418 aqueous humor liquid biopsies from patients undergoing intraocular surgery. Methods Free-text EHR searches were performed using the Stanford Research Repository cohort discovery tool to identify complications associated with anterior chamber paracentesis and subsequent endophthalmitis. Complications of the surgery unrelated to the biopsy were not reviewed. Main Outcome Measures Biopsy-associated intraoperative complications and endophthalmitis. Results A total of 1418 aqueous humor liquid biopsies were performed by 17 experienced surgeons. EHR free-text searches were 100% error-free for surgical complications, >99% for endophthalmitis (<1% false positive), and >93.6% for anesthesia type, requiring manual review for only a limited number of cases. More than 85% of cases were performed under local anesthesia without ocular muscle akinesia. Although the most common indication was cataract (50.1%), other diagnoses included glaucoma, diabetic retinopathy, uveitis, age-related macular degeneration, endophthalmitis, retinitis pigmentosa, and uveal melanoma. A 50- to 100-μL sample was collected in all cases using either a 30-gauge needle or a blunt cannula via a paracentesis. The median follow-up was >7 months. There was only one minor complication (0.07%) identified: a case of a small tear in Descemet membrane without long-term sequelae. No other complications occurred, including other corneal injuries, lens or iris trauma, hyphema, or suprachoroidal hemorrhage. There was no case of postoperative endophthalmitis. Conclusions Anterior chamber liquid biopsy during intraocular surgery is a safe procedure and may be considered for large-scale collection of aqueous humor samples for molecular analyses. Free-text EHR searches are an efficient approach to reviewing intraoperative procedures. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Julian Wolf
- Department of Ophthalmology, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
- Faculty of Medicine, Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - Teja Chemudupati
- Department of Ophthalmology, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Aarushi Kumar
- Department of Ophthalmology, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Joel A Franco
- Department of Ophthalmology, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Artis A Montague
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Charles C Lin
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Wen-Shin Lee
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - A Caroline Fisher
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Jeffrey L Goldberg
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Prithvi Mruthyunjaya
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Robert T Chang
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
| | - Vinit B Mahajan
- Department of Ophthalmology, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Kidd C, Loxton NJ, Uhlmann LR, Donovan CL. Integrating social media, body shame and psychological distress within the Elaborated Sociocultural Model. Body Image 2024; 50:101723. [PMID: 38788591 DOI: 10.1016/j.bodyim.2024.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
The Elaborated Sociocultural Model proposes exposure to sociocultural appearance pressures increases women's internalisation of the thin ideal, their engagement in social comparison and body surveillance, and subsequent body dissatisfaction and disturbances in eating (Fitzsimmons-Craft et al., 2011). Although this model has received some empirical support, it is limited in that it does not currently account for social media as a contemporary source of appearance pressure, nor include additional known outcomes of thin ideal internalisation (i.e., body shame, psychological distress). The current study tested the integration of these variables within the Elaborated Sociocultural Model. Using structural equation modelling with latent variables, the extended model provided acceptable to good fit to the data in a sample of 271 female participants. A latent variable representing sociocultural appearance pressures originating from social media, traditional media, family and peers was found to significantly predict thin ideal internalisation and body image concerns. Furthermore, both social comparison and body surveillance emerged as indirect mediators of the relationship between thin ideal internalisation and body image concerns, which in turn, increased report of restrained eating and psychological distress. Aligning with previous research, this extended model offers a useful and comprehensive framework for investigating women's body image.
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Affiliation(s)
- Chloe Kidd
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - Natalie J Loxton
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Laura R Uhlmann
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia; Griffith University Centre for Mental Health, Griffith University, Queensland, Australia
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Hunter B, Montgomery B, Sridhar A, Markant J. Endogenous Control and Reward-based Mechanisms Shape Infants' Attention Biases to Caregiver Faces. Dev Psychobiol 2024; 66:e22521. [PMID: 38952248 DOI: 10.1002/dev.22521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 07/03/2024]
Abstract
Infants rely on developing attention skills to identify relevant stimuli in their environments. Although caregivers are socially rewarding and a critical source of information, they are also one of many stimuli that compete for infants' attention. Young infants preferentially hold attention on caregiver faces, but it is unknown whether they also preferentially orient to caregivers and the extent to which these attention biases reflect reward-based attention mechanisms. To address these questions, we measured 4- to 10-month-old infants' (N = 64) frequency of orienting and duration of looking to caregiver and stranger faces within multi-item arrays. We also assessed whether infants' attention to these faces related to individual differences in Surgency, an indirect index of reward sensitivity. Although infants did not show biased attention to caregiver versus stranger faces at the group level, infants were increasingly biased to orient to stranger faces with age and infants with higher Surgency scores showed more robust attention orienting and attention holding biases to caregiver faces. These effects varied based on the selective attention demands of the task, suggesting that infants' attention biases to caregiver faces may reflect both developing attention control skills and reward-based attention mechanisms.
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Affiliation(s)
- Brianna Hunter
- Center for Mind and Brain, University of California Davis, Davis, California, USA
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Brooke Montgomery
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Aditi Sridhar
- Department of Psychology, Ashoka University, Sonipat, India
| | - Julie Markant
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
- Tulane Brain Institute, Tulane University, New Orleans, Louisiana, USA
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Mallbris MJ, Nymand LK, Andersen YMF, Egeberg A. Adult patients with alopecia areata report a significantly better medication adherence compared to those with atopic dermatitis: Results from a large cross-sectional cohort study. JAAD Int 2024; 16:79-86. [PMID: 38800704 PMCID: PMC11127029 DOI: 10.1016/j.jdin.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Alopecia areata (AA) and atopic dermatitis (AD) are chronic skin diseases where the suboptimal medication adherence (MA) may result in poor clinical outcomes. Objective To assess the impact of AA on MA among adults compared to AD. Methods Patient reported MA of adults with AA were compared with AD. Patients were identified from the Danish Skin Cohort, a nationwide prospective cohort of dermatological patients in Denmark. We used the Medication Adherence Report Scale- 5, a self-reporting questionnaire, to assess MA. Demographic and disease characteristics were collected. Logistic regression was conducted. Results Patients with AA reported higher MA than AD (mean 21.81 vs 18.29). Logistic regression analyses showed AA diagnosis had a statistically significant positive effect on MA (odds ratio = 3.94, 95% CI 2.01-8.89). Men reported significantly higher MA (odds ratio = 1.49, 95% CI 1.14-1.94). Current disease severity did not impact MA. Limitations Data were self-reported by patients. Data regarding the specific treatment undergone by patients were not available. Conclusion Patients with AA have significantly higher MA compared to patients with AD. The stability of AA patients' symptoms may lead to higher MA due to a desire for disease control. Conversely, the sporadicity of AD symptoms could negatively affect adherence, causing fluctuations in medication use.
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Affiliation(s)
| | - Lea Krog Nymand
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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de Oliveira ACS, Zacarias LC, de Souza CCC, Bezerra JPDS, Viana-Junior AB, Sobreira-Neto MA, Leite CF. Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea. Heart Lung 2024; 67:183-190. [PMID: 38848628 DOI: 10.1016/j.hrtlng.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. OBJECTIVES To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. METHODS One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. RESULTS Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.
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Affiliation(s)
- Ana Cecília Silva de Oliveira
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275
| | - Laíla Cândida Zacarias
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - Clarice Cristina Cunha de Souza
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - João Paulo da Silva Bezerra
- Department of Physical Therapy, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Major Weyne, 1440, Campus do Porangabussu, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Antônio Brazil Viana-Junior
- Clinical Research Unit of Hospital Universitario Walter Cantidio, Federal University of Ceara - EBSERH, Fortaleza, Brazil, Rua Coronel Nunes de Melo, Rodolfo Teófilo, ZIP Code: 60430-275
| | - Manoel Alves Sobreira-Neto
- Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil. R. Alexandre Baraúna, 949, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275; Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235.
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Şahin B, Çetin S, Sözen S, Aslan G, Çelik S, Türkeri L. A novel nomogram to predict clinically significant prostate cancer in MR assisted lesion biopsies: Turkish urooncology association nomogram. Urol Oncol 2024; 42:288.e17-288.e25. [PMID: 38782675 DOI: 10.1016/j.urolonc.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to develop a novel nomogram to predict clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion biopsies, addressing the challenges in deciding on biopsy for patients with PI-RADS 3 lesions and follow-up strategies for patients with negative PI-RADS 4 or 5 lesions. MATERIALS AND METHODS A retrospective case-control study was conducted using the Turkish Urooncology Association Databases (UROCaD). The final dataset included 2428 lesion biopsy data. Univariate analysis, logistic regression, and validation were performed, with 1942 and 486 lesion biopsy data in the training and validation datasets, respectively. RESULTS Age, initial total PSA value, PSA density, prostate volume, lesion length, DRE findings, and PI-RADS score were significantly different between benign or non-significant cancer and clinically significant prostate cancer groups. The developed nomogram incorporated PSA density, age, PI-RADS score, lesion length, and DRE findings. The mean area under the curve for the 6-fold cross-validation was 0.836, while the area under the curve values for the training and validation datasets were 0.827 and 0.861, respectively. The nomogram demonstrated a sensitivity of 75.6% and a specificity of 74.8% at a cut-off score of 24.9, with positive and negative predictive values of 42.2% and 92.6%, respectively. CONCLUSION The TUA nomogram, based on PSA density, age, PI-RADS score, lesion length, and DRE findings, provides a reliable and accurate prediction tool for detecting clinically significant prostate cancer in patients undergoing multi-parametric prostate MRI-assisted lesion (fusion) biopsies, potentially improving patient management and reducing unnecessary biopsies.
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Affiliation(s)
- Bahadır Şahin
- Urology Department, Marmara University School of Medicine, İstanbul, Turkey.
| | - Serhat Çetin
- Urology Department, Gazi University School of Medicine, Ankara, Turkey
| | - Sinan Sözen
- Urology Department, Gazi University School of Medicine, Ankara, Turkey
| | - Güven Aslan
- Urology Department, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Serdar Çelik
- Urology Department, University of Health Sciences Turkey, Izmir Faculty of Medicine, Izmir City Hospital, İzmir, Turkey
| | - Levent Türkeri
- Urology Department, Acıbadem University School of Medicine, İstanbul, Turkey
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Flores MJ, Brown KE, O'Marr JM, Adejuyigbe B, Rodarte P, Gomez-Alvarado F, Nwachuku K, Urva M, Shearer D. The economic impact of infection and/or nonunion on long-bone shaft fractures: a systematic review. OTA Int 2024; 7:e337. [PMID: 38863461 PMCID: PMC11164001 DOI: 10.1097/oi9.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/19/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
Background Long-bone fractures are a major cause of morbidity worldwide. These injuries are often complicated by infection or nonunion, which significantly affect patient quality of life and economic costs. Although studies have quantified the impact of these fractures, there is not a comprehensive review summarizing their economic and lifestyle costs. Study Objective This review summarized the impact of long-bone fracture infection and nonunion on health-related quality of life, as measured by utility scores, and both direct and indirect economic costs. Methods A systematic review was conducted using the following databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. The search included terms related to long-bone fractures, infection, nonunion, cost, and utility. The search yielded 1267 articles, and after deduplication, 1144 were screened, yielding 116 articles for full-text review. Screening was conducted using Covidence and extraction using REDCap. Results Twenty-two articles met inclusion criteria, with the majority being from the United States and Europe. Most articles were retrospective studies, predominantly regarding the tibia. Fifteen articles contained cost data and 8 contained utility data, with 1 article containing both. Ten cost articles and 1 utility article contained infection data. 8 cost and all utility articles contained nonunion data. Infection ranged from 1.5 to 8.0 times the cost of an uncomplicated fracture. Nonunion ranged from 2.6 to 4.3 times the cost of an uncomplicated fracture. Utility data were variable and ranged from 0.62 to 0.66 for infection and 0.48-0.85 for nonunion. Conclusions Infection and nonunion after long-bone fractures are associated with large decreases in health-related quality of life and incur substantial costs to both patients and health care systems. The data presented in this review quantify these impacts and may serve useful for future economic analyses. In addition, this study highlights the dearth of high-quality literature on this important topic.
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Affiliation(s)
- Michael J. Flores
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Kelsey E. Brown
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Jamieson M. O'Marr
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Babapelumi Adejuyigbe
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Patricia Rodarte
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Francisco Gomez-Alvarado
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Kelechi Nwachuku
- UCSF Department of Orthopaedics, University of California San Francisco, San Francisco, CA
| | - Mayur Urva
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - David Shearer
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
- UCSF Department of Orthopaedics, University of California San Francisco, San Francisco, CA
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15
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Chapman H, Ntemi PS, Gisiri M, Vasudevan L, Kashaigili HJ, Schroeder K. Retrospective analysis of pediatric patients with Burkitt lymphoma treated in Tanzania following the implementation of the 2016 National Treatment Guidelines: Poor outcomes to current standard-of-care therapy. Pediatr Blood Cancer 2024; 71:e31145. [PMID: 38924656 DOI: 10.1002/pbc.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the excellent outcomes achieved in the treatment of pediatric Burkitt lymphoma (BL) in high-income countries (HICs), outcomes remain poor in low- and middle-income countries (LMICs). Efforts to improve BL outcomes in Tanzania included the creation of National Treatment Guidelines in 2016. However, disease outcomes in Tanzania following the creation of these guidelines have not been reported to date. PROCEDURE Historical records from 2016 to 2021 for patients 0-18 years of age with a diagnosis of BL and seen at Bugando Medical Centre (BMC), in Mwanza, Tanzania, were curated into an electronic database and analyzed descriptively. Patients in this cohort were treated per the Tanzanian National Treatment Guidelines, which include six cycles of cyclophosphamide, vincristine, and methotrexate (COM) chemotherapy with intrathecal methotrexate and cytarabine. RESULTS In total, 92 BL patients' records were eligible for analysis. Patients in this cohort were most commonly Murphy stage II (28%) or stage III (34%). Nearly all, 91%, met International Network for Cancer Treatment and Research (INCTR) high-risk criteria at presentation. Forty-two percent of patients did not receive a biopsy and were treated with a presumed diagnosis of BL alone. A 1-year event-free survival of 29.6% (95% confidence interval [CI]: 20.3%-39.5%) and a 1-year overall survival of 38.5% (95% CI: 28%-48.9%) were observed. A high rate of treatment abandonment (34%) was also observed. CONCLUSION In a historical cohort of pediatric patients with BL treated per the 2016 Tanzanian National Treatment Guidelines, we observed poor outcomes and a high rate of abandonment. These outcomes appear inferior to those achieved in the INCTR clinical trial that informed the guidelines' creation, and highlights the importance of "real-world" outcomes data in LMICs. These data reinforce the idea that continued clinical research and capacity building efforts are necessary to improve BL outcomes in LMICs.
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Affiliation(s)
- Hutton Chapman
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, North Carolina, USA
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Heronima J Kashaigili
- Bugando Medical Centre, Mwanza, Tanzania
- Catholic University of Allied and Health Sciences, Mwanza, Tanzania
| | - Kristin Schroeder
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Bugando Medical Centre, Mwanza, Tanzania
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16
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Mosquera I, Barajas CB, Theriault H, Benitez Majano S, Zhang L, Maza M, Luciani S, Carvalho AL, Basu P. Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries. Int J Cancer 2024; 155:719-730. [PMID: 38648380 DOI: 10.1002/ijc.34950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user-provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user-directed interventions to increase demand, user-directed interventions to increase access, provider-directed interventions, and policy and system-level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider-directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Hannah Theriault
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Sara Benitez Majano
- Pan American Health Organization, Washington, DC, USA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Mauricio Maza
- Pan American Health Organization, Washington, DC, USA
| | | | - Andre L Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024; 60:1104-1116. [PMID: 38619698 PMCID: PMC11199219 DOI: 10.1007/s10597-024-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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18
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Tiase VL, Richards G, Taft T, Stevens L, Balbin C, Kaphingst KA, Fagerlin A, Caverly T, Kukhareva P, Flynn M, Butler JM, Kawamoto K. Patient Perspectives on a Patient-Facing Tool for Lung Cancer Screening. Health Expect 2024; 27:e14143. [PMID: 38992907 PMCID: PMC11239535 DOI: 10.1111/hex.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/02/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Individuals with high risk for lung cancer may benefit from lung cancer screening, but there are associated risks as well as benefits. Shared decision-making (SDM) tools with personalized information may provide key support for patients. Understanding patient perspectives on educational tools to facilitate SDM for lung cancer screening may support tool development. AIM This study aimed to explore patient perspectives related to a SDM tool for lung cancer screening using a qualitative approach. METHODS We elicited patient perspectives by showing a provider-facing SDM tool. Focus group interviews that ranged in duration from 1.5 to 2 h were conducted with 23 individuals with high risk for lung cancer. Data were interpreted inductively using thematic analysis to identify patients' thoughts on and desires for a patient-facing SDM tool. RESULTS The findings highlight that patients would like to have educational information related to lung cancer screening. We identified several key themes to be considered in the future development of patient-facing tools: barriers to acceptance, preference against screening and seeking empowerment. One further theme illustrated effects of patient-provider relationship as a limitation to meeting lung cancer screening information needs. Participants also noted several suggestions for the design of technology decision aids. CONCLUSION These findings suggest that patients desire additional information on lung cancer screening in advance of clinical visits. However, there are several issues that must be considered in the design and development of technology to meet the information needs of patients for lung cancer screening decisions. PATIENT OR PUBLIC CONTRIBUTION Patients, service users, caregivers or members of the public were not involved in the study design, conduct, analysis or interpretation of the data. However, clinical experts in health communication provided detailed feedback on the study protocol, including the focus group approach. The study findings contribute to a better understanding of patient expectations for lung cancer screening decisions and may inform future development of tools for SDM.
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Affiliation(s)
- Victoria L Tiase
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Grace Richards
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Christian Balbin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Tanner Caverly
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Polina Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael Flynn
- Departments of Internal Medicine and Pediatrics, Community Physicians Group, University of Utah Health, Salt Lake City, Utah, USA
| | - Jorie M Butler
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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Clynes S, Moran A, Cardel M, Foster G, Phelan S. Weight Loss Maintainers Sustain High Diet Quality in Diverse Residential Retail Food Environments. J Acad Nutr Diet 2024; 124:957-963.e3. [PMID: 38556111 DOI: 10.1016/j.jand.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/09/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The relationship between the retail food environment and diet quality has received minimal investigation among weight loss maintainers. OBJECTIVE The aim of this study was to investigate the association between the residential retail food environment and diet quality in weight loss maintainers from WeightWatchers in the United States. DESIGN Cross-sectional data were collected between January 2018 and February 2020. The Retail Food Environment Index (RFEI), based on geocoded home addresses, classified the environment as follows: RFEI <1.6 = healthiest; RFEI 1.6 to <2.5 = moderately healthy; RFEI 2.5 to <4.0 = moderately unhealthy; RFEI ≥4.0 = least healthy. Dietary data were obtained using a food frequency questionnaire. PARTICIPANTS/SETTING Adult participants (n = 1,159) who had lost weight using WeightWatchers and maintained ≥9.1-kg weight loss for ≥1 year (mean 24.7-kg loss for 3.4 years). MAIN OUTCOME MEASURES Healthy Eating Index 2015 (HEI-2015) component and total scores (0-100; higher scores indicate better alignment with the 2015-2020 Dietary Guidelines for Americans). STATISTICAL ANALYSES PERFORMED Regression models included RFEI category, the independent variable, and HEI-2015 and component scores (outcomes) controlling for age, sex, race and ethnicity, educational attainment, and household income. RESULTS Compared with individuals living in the healthiest food environments (mean HEI-2015 score = 71.5) those in the unhealthiest environments had a mean HEI-2015 score of 70.1 (95% CI 68.8 to 71.3), those in moderately unhealthy environments had a score of 71.3 (95% CI 70.3 to 73.1) and those in moderately healthy environments had a score of 70.3 (95% CI 68.9 to 71.2), indicating a nonlinear relationship. Compared with those in the healthiest environments, those in the least healthy environments had an approximately 0.47 lower added sugar HEI-2015 component score (95% CI -0.86 to -0.08), indicating approximately 5% higher added sugar intake. CONCLUSIONS Weight loss maintainers maintained high diet quality in diverse retail food environments. Compared with those in the healthiest food environments, those in the least healthy had a higher consumption of added sugars.
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Affiliation(s)
- Sasha Clynes
- Department of Health Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Alyssa Moran
- Department of Health Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle Cardel
- WeightWatchers, New York, New York; Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - Gary Foster
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Phelan
- Departments of Kinesiology and Public Health and Center for Health Research, California Polytechnic State University, San Luis Obispo, California
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Artal JM, Randall L, Rubeck S, Allyse M, Michie M, Riggan KA, Meredith S, Skotko BG. Parents of children with Down syndrome reflect on their postnatal diagnoses, 2003-2022. Am J Med Genet A 2024; 194:e63619. [PMID: 38619097 DOI: 10.1002/ajmg.a.63619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
A 2003 survey revealed the scope of mothers' dissatisfaction with their postnatal support following a diagnosis of Down syndrome (DS). Substantial proportions of mothers reported that providers conveyed diagnoses with pity, emphasized negative aspects of DS, and neglected to provide adequate materials explaining DS. This study follows up on the 2003 survey by assessing whether parents' experiences have improved. Four DS nonprofit organizations, which participated in the original study, distributed a mixed-methods survey to families who have had children with DS between 2003 and 2022. Quantitative analysis assessed correlations among responses and differences between the 2003 and 2022 survey groups. Open-ended responses were qualitatively analyzed. Compared to the 2003 findings, parents' perceptions of their postnatal care have not improved (N = 89). Parents are increasingly likely to report that their providers pitied them, omitted positive aspects of DS, and provided insufficient materials describing DS. Substantial proportions of parents reported fear (77%) and anxiety (79%), only 24% described receiving adequate explanatory materials, and parents were 45% likelier to report that physicians discussed negative aspects of DS than positive aspects. Qualitatively, substantial numbers of parents recounted insensitive conduct by providers. These results suggest that despite interventions, parents' experiences of postnatal diagnoses of DS have not improved over time. Certain provider behaviors-such as describing positive aspects of DS and providing comprehensive explanatory materials-can reduce fear and anxiety, pointing to directions for reform.
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Affiliation(s)
- Jonathan M Artal
- Stanford Law School, Stanford University, Stanford, California, USA
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lindsey Randall
- The Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Sabina Rubeck
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Megan Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Marsha Michie
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephanie Meredith
- Human Development Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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21
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Carpenter SM, Shetty A, Hetzel SJ, Garza K, Porter LS, Gray KE, Shaw RJ, Lewis MA, Mao L, Pabich S, Johnson HM, Yancy WS, Elwert F, Voils CI. A non-randomized comparison of engagement and outcomes for in-person versus virtual delivery of the Partner2Lose weight management trial. Obes Sci Pract 2024; 10:e778. [PMID: 39045420 PMCID: PMC11265462 DOI: 10.1002/osp4.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective Existing behavioral weight management interventions produce clinically meaningful weight loss. The onset of the COVID-19 pandemic led to the quick transition of such interventions from in-person to virtual platforms. This provided a unique opportunity to compare engagement and outcomes for an in-person versus virtually delivered weight management intervention. Methods A non-randomized comparison of engagement and weight outcomes was performed between two cohorts who participated in a weight management intervention in person (N = 97) versus three who participated virtually via videoconference (N = 134). Various metrics of engagement were examined, including group class and individual phone call attendance and duration, and retention for weight assessments. Behavioral targets of daily caloric intake and step-counts and the clinical weight outcome were explored. Results Cohorts (mean [standard deviation] age 47.3 (11.5), 67.1% women: 86.8% White) that participated virtually attended more group sessions (p < 0.001) and had maintenance telephone calls that were of a longer duration (p < 0.001). No other engagement or weight outcomes significantly differed by delivery modality. Conclusions Virtual weight management programs are promising and may generate similar outcomes to those delivered in-person. Future research should seek to understand how best to promote and sustain engagement in virtual interventions.
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Affiliation(s)
| | - Armaan Shetty
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Scott J. Hetzel
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Katya Garza
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Laura S. Porter
- Psychiatry & Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kristen E. Gray
- Department of Veterans Affairs Puget Sound Health Care SystemHealth Services Research & DevelopmentSeattleWashingtonUSA
- Health Systems and Population HealthSchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Ryan J. Shaw
- School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | - Megan A. Lewis
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Lu Mao
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Samantha Pabich
- Department of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness InstituteBaptist Health South FloridaCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - William S. Yancy
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Felix Elwert
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of SociologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corrine I. Voils
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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22
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Wall AE, Da Graca B, Asrani SK, Ruiz R, Fernandez H, Gupta A, Martinez E, Bayer J, McKenna G, He Lee S, Trotter JF, Testa G. A cost comparison of liver acquisition fees for donation after circulatory death versus donation after brain death donors. Liver Transpl 2024; 30:775-784. [PMID: 38190240 DOI: 10.1097/lvt.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in the United States. Compared to donation after brain death, DCD is less likely to result in transplantation. For each potential donor whose organs cannot be utilized for transplantation (ie, dry run), fees are associated with the attempted donation, which add to the overall costs of organ acquisition. To better characterize the true costs of DCD liver acquisition, we performed a cost comparison of the fees associated with organ acquisition for DCD versus donation after brain death at a single transplant institute that comprises 2 liver transplant centers. Cost, recipient, and transportation data for all cases, including fees associated with liver acquisition from July 1, 2019, to October 31, 2021, were collected. We found that the total cost of DCD liver acquisition per liver transplant was $15,029 more than that for donation after brain death donation, with 18% of the costs of the DCD transplant attributed to dry runs. Overall, the costs associated with DCD transplantation accounted for 34.5% of the total organ acquisition costs; however, DCD transplantation accounted for 30.3% of the transplantation volume. Because the expansion of DCD is essential to increasing the availability of liver grafts for transplantation, strategies need to be implemented to decrease the costs associated with dry runs, including using local recovery, transferring donors to hospitals close to transplant centers, and performing more prerecovery organ analysis. Moreover, these strategies are needed to ensure that financial disincentives to DCD procurement and utilization do not reverse the gains made by expanding the organ donor pool using machine perfusion technologies.
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Affiliation(s)
- Anji E Wall
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
| | - Briget Da Graca
- Baylor, Scott and White Research Institute, Dallas, Texas, USA
| | | | - Richard Ruiz
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
| | | | - Amar Gupta
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
| | - Eric Martinez
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
| | - Johanna Bayer
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
| | | | - Seung He Lee
- Baylor Simmons Transplant Institute, Dallas, Texas, USA
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Bjurström MF, Borgquist O, Kander T, Lundén R, Fagerlund MJ, Lipcsey M, Sturesson LW. Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists. Acta Anaesthesiol Scand 2024; 68:923-931. [PMID: 38686931 DOI: 10.1111/aas.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross-sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care. METHODS A 20-item multiple-choice-question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3-month period, September-November 2023. RESULTS The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55-9.67), p < .001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13-2.58), p = .011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi-tasking. Approximately half of respondents expressed that audio podcast-based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills. CONCLUSION Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer-review processes, and potential sex-differences.
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Affiliation(s)
| | - Ola Borgquist
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Robin Lundén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Malin J Fagerlund
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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24
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Vested M, Kempff-Andersen S, Creutzburg A, Dalsten H, Wadland SS, Rosenkrantz O, Rosager CL, Rasmussen LS. Onset time, duration of action, and intubating conditions after mivacurium in elderly and younger patients. Acta Anaesthesiol Scand 2024; 68:898-905. [PMID: 38764184 DOI: 10.1111/aas.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The neuromuscular blocking agent mivacurium can be used during anesthesia to facilitate tracheal intubation. Data on onset time, duration of action, and effect on intubating conditions in patients 80 years and older are however limited. We hypothesized that onset time and duration of action of mivacurium would be longer in elderly patients than in younger adults. METHODS This prospective observational study included 35 elderly (≥80 years) and 35 younger (18-40 years) patients. Induction of anesthesia comprised fentanyl 1-3 μg kg-1 and propofol 1.5-2.5 mg kg-1 and propofol and remifentanil for maintenance. Acceleromyography was used for monitoring neuromuscular blockade. The primary outcome was onset time defined as time from injection of mivacurium 0.2 mg kg-1 to a train-of-four (TOF) count of zero. Other outcomes included duration of action (time to TOF ratio ≥0.9), intubating conditions using the Fuchs-Buder scale and the intubating difficulty scale (IDS), and occurrence of hoarseness and sore throat postoperatively. RESULTS No difference was found in onset time comparing elderly with younger patients; 219 s (SD 45) versus 203 s (SD 74) (difference: 16 s (95% CI: -45 to 14), p = .30). Duration of action was significantly longer in elderly patients compared with younger patients; 52 min (SD 17) versus 30 min (SD 8) (difference: 22 min [95% CI: 15 to 28], p < .001). No difference was found in the proportion of excellent intubating conditions (Fuchs-Buder); 31/35 (89%) versus 26/35 (74%) (p = .12) or IDS score (p = .13). A larger proportion of younger patients reported sore throat 24 h postoperatively; 34% versus 0%, p = .0002. No difference was found in hoarseness. CONCLUSION No difference in onset time of mivacurium 0.2 mg kg-1 was found comparing elderly and younger patients. However, elderly patients had significantly longer duration of action. No difference was found in intubating conditions.
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Affiliation(s)
- Matias Vested
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Kempff-Andersen
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Creutzburg
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Helene Dalsten
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Sofie Wadland
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Oscar Rosenkrantz
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christine L Rosager
- Department of Anesthesia, Herlev Hospital, Herlev, Denmark
- Danish Cholinesterase Research Unit, Department of Anesthesia, Herlev Hospital, Herlev, Denmark
| | - Lars S Rasmussen
- Danish Ministry of Defence Personnel Agency, Copenhagen, Denmark
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25
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Del Risco A, Cherches A, Polcaro L, Washabaugh C, Hales R, Jiang R, Allori A, Raynor E. Improving Health Literacy of Elective Procedures in Pediatric Otolaryngology. Otolaryngol Head Neck Surg 2024; 171:546-553. [PMID: 38520236 DOI: 10.1002/ohn.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology. STUDY DESIGN Prospective randomized crossover design. SETTING Tertiary Academic Center. METHODS From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6-question baseline test based on the information. They each watched a 2-minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6-questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed-rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences. RESULTS Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed-rank test indicated that postresource scores were statistically significantly higher (P < .001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process. CONCLUSION The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure-specific resources can supplement the consent process and ensure decision-makers have adequate health literacy for informed decision-making.
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Affiliation(s)
- Amanda Del Risco
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Cherches
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Polcaro
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Claire Washabaugh
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robin Hales
- Department of Child Life, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rong Jiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Allori
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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26
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Ye Y, Acevedo-Mendez BA, Izard S, Myers AK. Differences in Glycemic Control for Inpatients with Type 1 Diabetes on Insulin Pump Versus Subcutaneous Insulin Therapy. J Gen Intern Med 2024; 39:1895-1900. [PMID: 38587726 PMCID: PMC11282042 DOI: 10.1007/s11606-024-08736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users. OBJECTIVE To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI). DESIGN Retrospective chart review. PARTICIPANTS Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area. MAIN MEASURES Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events). RESULTS The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227). CONCLUSIONS In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.
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Affiliation(s)
- Yuting Ye
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA.
| | - Bernardo A Acevedo-Mendez
- Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Stephanie Izard
- Quantitative Intelligence, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Alyson K Myers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
- Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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27
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Wong D, Osland E, Carey S. Funding and resource availability for home parenteral nutrition in Australia: A national cross-sectional survey. JPEN J Parenter Enteral Nutr 2024; 48:693-699. [PMID: 38850512 DOI: 10.1002/jpen.2656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-saving therapy required for the management of type III intestinal failure, one of the rarest organ failures. It requires a multidisciplinary approach to manage the complexity of the underlying medical, surgical, and nutrition issues, but the current levels of healthcare funding in Australia are unknown. This study aimed to quantify the caseload, staffing, and capacity of existing HPN centers nationally. METHODS This was a cross-sectional survey inviting centers known to provide HPN care. The survey was designed to capture metrics related to the national framework for the delivery of HPN. These centered on staffing levels, patient load, capacity to audit key outcomes, and service challenges. RESULTS A total of 24 (89%) of 27 invited centers responded to the survey. There were 17 (71%) adult centers and 7 (29%) pediatric centers. Adult centers managed a median of 12 (interquartile range [IQR]: 6-25) patients vs 16 (IQR: 9-17) in pediatric centers. Several centers did not have dedicated funding for core team members. The total funded clinician time each week per patient was 7 min (IQR: 0-12 min) in adult centers and 14 min (IQR: 10-21 min) in pediatric centers. Fewer than half of centers reported having sufficient resources to regularly audit key metrics. CONCLUSION The availability of dedicated expertise to manage the highly complex needs of people living with type III intestinal failure is lacking in Australia. Current funding of HPN services falls well short of being sufficient to meet the requirements outlined in the national quality framework.
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Affiliation(s)
- Darren Wong
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Emma Osland
- Department of Dietetics and Foodservices, Royal Brisbane and Woman's Hospital, Brisbane, Queensland, Australia
- School of Human Movement and Nutrition Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Sharon Carey
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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28
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Salloum JA, Garten L, Bührer C. Diuresis-led volume replacement strategy in extremely low birth weight infants. Acta Paediatr 2024. [PMID: 39087573 DOI: 10.1111/apa.17362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
AIM In extremely low birth weight infants, fluid overload has been associated with bronchopulmonary dysplasia and death. Excessive weight loss may increase the risk of meconium obstruction and intestinal perforation. As these infants display oliguria followed by polyuria, we embarked on a diuresis-led volume replacement strategy as of January 2020. METHODS This single-centre analysis presents data of infants <1000 g birth weight surviving for more than 3 days admitted 2017-2019 (n = 217, daily volume increase) versus 2020-2022 (n = 2022, diuresis-led volume replacement). RESULTS The second cohort had lower gestational age (median [interquartile range]: 253/7 [243/7-264/7] vs. 263/7 [251/7-282/7] weeks), less antenatal steroids (58% vs. 69%), more indomethacin (66% vs. 47%) and higher initial diuresis (5.6 [4.9-6.8] vs. 4.8 [4.2-5.5] mL/kg/h) but did not differ by relative weight loss at Day 7 of life. Employing binary logistic regression with gestational age, antenatal steroids and indomethacin as covariates, the cohorts did not differ by rates of patent ductus arteriosus, abdominal surgery or severe retinopathy of prematurity, while there were significant declines in sepsis (from 32% to 19%), bronchopulmonary dysplasia (from 26% to 23%) and mortality (from 13% to 7%). CONCLUSION Diuresis-led volume replacement appears to be safe and maybe beneficial.
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Affiliation(s)
- Jonas Abbas Salloum
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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29
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Hassinger AB, Mody K, Gomez R, Wrotniak BH, Falkowski K, Breuer R, Mennie C, Flagg LK. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med 2024; 20:1251-1258. [PMID: 38456806 DOI: 10.5664/jcsm.11116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVES Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multicenter trials exploring PICU-SCD have been impractical because measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU. METHODS This prospective, multicenter, case-control study enrolled caregivers of children in 4 PICUs or in a hospital-based sleep laboratory (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability. RESULTS In responses from 152 PICU and 61 sleep laboratory caregivers, sleep survey items had acceptable internal reliability (α = 0.75) and reproducibility on retest surveys (interclass correlation coefficient > 0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified 3 subscales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ = 0.823) and sleep onset latency (κ = 0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r = .844, P < .001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length. CONCLUSIONS The Survey of Sleep Quality in the Pediatric Intensive Care Unit provides a reliable, accurate description of inpatient sleep disruption in nonsedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations. CITATION Hassinger AB, Mody K, Gomez R, et al. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med. 2024;20(8):1251-1258.
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Affiliation(s)
- Amanda B Hassinger
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences and John R. Oishei Children's Hospital, Buffalo, New York
| | - Kalgi Mody
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Robert Wood Johnson Medical School and Bristol-Myers Squibb Children's Hospital, New Brunswick, New Jersey
| | - Raquel Gomez
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Brian H Wrotniak
- Department of Pediatrics, University at Buffalo School or Medicine and Biomedical Sciences, Buffalo, New York
| | - Kim Falkowski
- Master of Public Health Program, Daemen University, Amherst, New York
| | - Ryan Breuer
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University at Buffalo School of Medicine and Biomedical Sciences and John R. Oishei Children's Hospital, Buffalo, New York
| | - Colleen Mennie
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren K Flagg
- Pediatric Intensive Care Unit, Yale New Haven Children's Hospital, New Haven, Connecticut
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Coe R, Toke S, Wallace H, Riggs E, Brown SJ, Szwarc J, Biggs LJ. When I can be my whole authentic self, I feel safe and know that I belong: a photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia. ETHNICITY & HEALTH 2024; 29:720-744. [PMID: 38867355 DOI: 10.1080/13557858.2024.2359388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. DESIGN A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. RESULTS Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. CONCLUSION When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.
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Affiliation(s)
- Rowena Coe
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Shadow Toke
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Heather Wallace
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
- School of Nursing and Midwifery, Institute of Health Transformation, Deakin University, Geelong, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture Inc., Brunswick, Australia
| | - Laura J Biggs
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
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Denoble AE, Vazquez-Benitez G, Sheth SS, Ackerman-Banks CM, DeSilva MB, Zhu J, Daley MF, Getahun D, Klein NP, Vesco KK, Irving SA, Nelson J, Williams JTB, Hambidge SJ, Donahue JG, Weintraub ES, Kharbanda EO, Lipkind HS. Coronavirus Disease 2019 (COVID-19) Vaccination and Stillbirth in the Vaccine Safety Datalink. Obstet Gynecol 2024; 144:215-222. [PMID: 38843526 PMCID: PMC11250101 DOI: 10.1097/aog.0000000000005632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) vaccination is recommended in pregnancy to reduce the risk of severe morbidity from COVID-19. However, vaccine hesitancy persists among pregnant people, with risk of stillbirth being a primary concern. Our objective was to examine the association between COVID-19 vaccination and stillbirth. METHODS We performed a matched case-control study in the Vaccine Safety Datalink (VSD). Stillbirths and live births were selected from singleton pregnancies among persons aged 16-49 years with at least one prenatal, delivery, or postpartum visit at eight participating VSD sites. Stillbirths identified through diagnostic codes were adjudicated to confirm the outcome, date, and gestational age at fetal death. Confirmed antepartum stillbirths that occurred between February 14, 2021, and February 27, 2022, then were matched 1:3 to live births by pregnancy start date, VSD site, and maternal age at delivery. Associations among antepartum stillbirth and COVID-19 vaccination in pregnancy, vaccine manufacturer, number of vaccine doses received, and vaccination within 6 weeks before stillbirth (or index date in live births) were evaluated using conditional logistic regression. RESULTS In the matched analysis of 276 confirmed antepartum stillbirths and 822 live births, we found no association between COVID-19 vaccination during pregnancy and stillbirth (38.4% stillbirths vs 39.3% live births in vaccinated individuals, adjusted odds ratio [aOR] 1.02, 95% CI, 0.76-1.37). Furthermore, no association between COVID-19 vaccination and stillbirth was detected by vaccine manufacturer (Moderna: aOR 1.00, 95% CI, 0.62-1.62; Pfizer-BioNTech: aOR 1.00, 95% CI, 0.69-1.43), number of vaccine doses received during pregnancy (1 vs 0: aOR 1.17, 95% CI, 0.75-1.83; 2 vs 0: aOR 0.98, 95% CI, 0.81-1.17), or COVID-19 vaccination within the 6 weeks before stillbirth or index date compared with no vaccination (aOR 1.16, 95% CI, 0.74-1.83). CONCLUSION No association was found between COVID-19 vaccination and stillbirth. These findings further support recommendations for COVID-19 vaccination in pregnancy.
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Affiliation(s)
- Anna E Denoble
- Yale School of Medicine, New Haven, Connecticut; HealthPartners Institute, Bloomington, Minnesota; Baylor College of Medicine, Houston, Texas; Institute for Health Research, Kaiser Permanente Colorado, and Ambulatory Care Services, Denver Health, Denver, Colorado; Kaiser Permanente Southern California, Pasadena, and Kaiser Permanente Vaccine Study Center, Oakland, California; Kaiser Permanente Center for Health Research, Portland, Oregon; Kaiser Permanente, Seattle, Washington; Marshfield Clinic Research Institute, Marshfield, Wisconsin; Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia; and Weill-Cornell School of Medicine, New York, New York
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Giummarra MJ, Reeder S, Williams S, Devlin A, Knol R, Ponsford J, Arnold CA, Konstantatos A, Gabbe BJ, Clarke H, Katz J, Mitchell F, Robinson E, Zatzick D. Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial. Disabil Rehabil 2024; 46:3643-3659. [PMID: 37706486 PMCID: PMC10937328 DOI: 10.1080/09638288.2023.2254235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/29/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. MATERIALS AND METHODS Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. RESULTS Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. CONCLUSIONS Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandra Reeder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Scott Williams
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
| | - Anna Devlin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rose Knol
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Social Work, Alfred Health, Melbourne, Victoria, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria, Australia
| | - Carolyn A. Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
- Academic Board of Anaesthesia & Perioperative Medicine, School of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Alex Konstantatos
- Department of Anaesthesia, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, Wales, UK SA2 8PP
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Psychology, York University, Toronto, ON M3J 1P3
| | - Fiona Mitchell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Patient and carer coinvestigators with lived experience of trauma
| | - Elizabeth Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Patient and carer coinvestigators with lived experience of trauma
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
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Geist NC, Browning M, Messick A. Development of a Critical Reflection Mentorship Program to Enhance Critical Thinking Among Novice Nurses. J Contin Educ Nurs 2024:1-5. [PMID: 39088688 DOI: 10.3928/00220124-20240718-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND The increasing complexity of care and the decrease in overall nursing experience pose a threat to patient safety and clinical outcomes in health care. Within the local environment, a critical need was identified to connect expert bedside nurses with novice nurses to support the development of critical thinking. METHOD This article describes the development and pilot evaluation of a critical reflection mentorship program, Beyond the Bedside. The program was developed and deployed in three inpatient units within an adult academic health center. Critical thinking was evaluated using the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) pre- and postprogram implementation. RESULTS Five nurses participated in the pre- and postevaluation, and the N-CT-4 Practice mean scores were significantly higher after program implementation. CONCLUSION Education leaders should prioritize programs that support critical thinking among novice nurses, and the Beyond the Bedside program can be adapted for use in other health care settings. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].
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Rajagopalan A, Aroori S, Russell TB, Labib PL, Ausania F, Pando E, Roberts KJ, Kausar A, Mavroeidis VK, Marangoni G, Thomasset SC, Frampton AE, Lykoudis P, Maglione M, Alhaboob N, Bari H, Smith AM, Spalding D, Srinivasan P, Davidson BR, Bhogal RH, Dominguez I, Thakkar R, Gomez D, Silva MA, Lapolla P, Mingoli A, Porcu A, Shah NS, Hamady ZZR, Al-Sarrieh B, Serrablo A, Croagh D. Five-year recurrence/survival after pancreatoduodenectomy for pancreatic adenocarcinoma: does pre-existing diabetes matter? Results from the Recurrence After Whipple's (RAW) study. HPB (Oxford) 2024; 26:981-989. [PMID: 38755085 DOI: 10.1016/j.hpb.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/27/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) has a complex relationship with pancreatic cancer. This study examines the impact of preoperative DM, both recent-onset and pre-existing, on long-term outcomes following pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). METHODS Data were extracted from the Recurrence After Whipple's (RAW) study, a multi-centre cohort of PD for pancreatic head malignancy (2012-2015). Recurrence and five-year survival rates of patients with DM were compared to those without, and subgroup analysis performed to compare patients with recent-onset DM (less than one year) to patients with established DM. RESULTS Out of 758 patients included, 187 (24.7%) had DM, of whom, 47 of the 187 (25.1%) had recent-onset DM. There was no difference in the rate of postoperative pancreatic fistula (DM: 5.9% vs no DM 9.8%; p = 0.11), five-year survival (DM: 24.1% vs no DM: 22.9%; p = 0.77) or five-year recurrence (DM: 71.7% vs no DM: 67.4%; p = 0.32). There was also no difference between patients with recent-onset DM and patients with established DM in postoperative outcomes, recurrence, or survival. CONCLUSION We found no difference in five-year recurrence and survival between diabetic patients and those without diabetes. Patients with pre-existing DM should be evaluated for PD on a comparable basis to non-diabetic patients.
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Affiliation(s)
| | | | | | - Peter L Labib
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | - Keith J Roberts
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | | | | | | | - Hassaan Bari
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | | | | | | | | | - Ismael Dominguez
- Salvador Zubiran National Institute of Health Sciences and Nutrition, Mexico City, Mexico
| | - Rohan Thakkar
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dhanny Gomez
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael A Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Andrea Mingoli
- Policlinico Umberto I University Hospital Sapienza, Rome, Italy
| | - Alberto Porcu
- Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Nehal S Shah
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Zaed Z R Hamady
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Hoyt CR, Luo L, Rice HE, Shivakumar N, Housten AJ, Picinich A, Qashou N, Harris KM, Varughese T, King AA. "Everyone screens to some extent": Barriers and facilitators of developmental screening among children with sickle cell disease: A mixed methods study. Pediatr Blood Cancer 2024; 71:e31060. [PMID: 38757454 DOI: 10.1002/pbc.31060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Developmental delays are common among children with sickle cell disease (SCD). Existing guidelines support consistent screening to increase the identification of deficits and support referral to rehabilitative interventions, yet adherence remains variable. This study sought to assess current practices and identify barriers and facilitators to improve developmental screening for children 0-3 years with SCD. PROCEDURE A mixed methods approach, guided by the Exploration and Preparation stages of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, assessed developmental screening practices among primary care providers and hematologists. Phase 1 included the SCD Developmental Surveillance and Screening Guideline and Practice Survey. Phase 2 included the SCD Developmental Screening Organizational Survey alongside semi-structured interviews. Descriptive and qualitative methods summarized the findings. RESULTS Thirty-three providers from general pediatrics and hematology completed phase 1. Use of standardized developmental screening measures was variable, with the most frequently used being the Modified Checklist for Autism in Toddlers (77%) and the Ages and Stages Questionnaire (55%). Fifteen providers participated in phase 2, and reported they were most likely to engage in changes to improve their practice (mean = 4.4/5) and least likely to support spiritual health and well-being (mean = 3.5/5). Three themes emerged:(i) developmental screening is not standardized or specific to SCD, (ii) children with SCD benefit from a multidisciplinary team, and (iii) healthcare system limitations are a barrier. CONCLUSIONS Developmental screening is inconsistent and insufficient for young children with SCD. Providers are interested in supporting children with SCD, but report a lack of standardized measures and consistent guidance as barriers.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lingzi Luo
- School of Global Public Health, New York University, New York, New York, USA
| | - Hannah E Rice
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nirmala Shivakumar
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashley J Housten
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Abigail Picinich
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nai Qashou
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly M Harris
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Taniya Varughese
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Education, Washington University School of Medicine, St. Louis, Missouri, USA
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Curtis K, Clark B, Lam MK, Huckle R, Melville G, Binks S, Ryan MW, Gardner T, Parsons MB, Ashford B. Rethinking the tiered trauma team response: A case-series study in a regional trauma centre. Emerg Med Australas 2024; 36:571-578. [PMID: 38451003 DOI: 10.1111/1742-6723.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/12/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To reduce perceived unnecessary resource use, we modified our tiered trauma response. If a patient was not physiologically compromised, surgical registrar attendance was not mandated. We investigated the effect of this change on missed injury, unplanned representation to ED, diagnostic imaging rates and staff satisfaction. METHODS A retrospective case series study assessing the 3-month period before and after the intervention was conducted. Logistic regression analyses were used to examine the association between ordering of computerised tomography (CT) and ED length of stay (LOS), injury severity (ISS), age, surgical review and admission. A staff survey was conducted to investigate staff perceptions of the practice change. Free text data were analysed using inductive content analysis. RESULTS There were 105 patients in the control and 166 in the intervention group and their mean (SD) ISS was the same (ISS [SD] = 4 [±4] [P = 0.608]). A higher proportion of the control group were admitted (56.3% vs 42.2% [P = 0.032]) and they had a shorter ED LOS (274 min [202-456] vs 326 min [225-560], P = 0.044). The rate of missed injury was unchanged. A surgical review resulted in a 26-fold increase in receipt of a whole-body CT scan (odds ratio = 26.89, 95% confidence interval = 3.31-218.17). Just over half of survey respondents felt the change was safe (54.4%), and more surgical (90%) than ED staff (69%) reported the change as positive. CONCLUSION The removal of the surgical registrar from the initial trauma standby response did not result in any adverse events, reduced admissions, pathology and imaging, but resulted in an increased ED LOS and time to surgical review.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Benjamin Clark
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mary K Lam
- Department of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Ryan Huckle
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Geoffrey Melville
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
- Research Operations, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Faulty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Simon Binks
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ms Wende Ryan
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Trevor Gardner
- Emergency Department, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ms Brooke Parsons
- Emergency Department, Southern NSW Local Health District, Cooma Hospital, Cooma, New South Wales, Australia
| | - Bruce Ashford
- Research Operations, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Faulty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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George J, Tuli S, Patel PP, Monare B, Ramogola-Masire D, Bazzett-Matabele L, Bvochora-Nsingo M, Chiyapo S, Ralefala T, Vuylsteke P, Rendle KA, Grover S. Delays in Cervical Cancer Treatment Initiation for Patients Living With or Without HIV in Botswana: An Observational Cohort Analysis (2015-2019). Int J Radiat Oncol Biol Phys 2024; 119:1368-1378. [PMID: 38462016 DOI: 10.1016/j.ijrobp.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/04/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To assess delays in treatment initiation of chemoradiation or radiation alone for patients with advanced stage cervical cancer in Botswana. METHODS AND MATERIALS Females with locally advanced cervical cancer (stages IB2-IVB) were prospectively enrolled in an observational cohort study from 2015 to 2019. We evaluated delays at 30, 60, 90, 120, 150, and 180 or greater days between the date of diagnosis and treatment initiation. Factors associated with overall survival were modeled with multivariable Cox proportional hazards regression (aHR). Associations between delays in cervical cancer treatment initiation were evaluated via univariable logistic regression. RESULTS Among the 556 patients included (median age = 47.9 years), 386 (69.4%) were females living with HIV with a median CD4 count of 448.0 cells/μL (IQR, 283.0-647.5 cells/μL) at diagnosis. Most patients had stages 2 (38.1%) or 3 (34.5%) cervical cancer. Early-stage patients experienced longer delays in treatment initiation compared to late-stage patients (P = .033). Early-stage patients with delays ≥90 days and pathology diagnosis between 2016 and 2019 (aHR, 0.34; P < .001) versus <90 days had a decreased risk of mortality, and those with delays ≥90 days and pathology diagnosis before 2016 (aHR, 5.67; P = .022) versus <90 days had an increased risk of mortality. Late-stage patients with delays ≥120 days and pathology diagnosis between 2018 and 2019 (aHR, 1.98; P = .025) versus <120 days had an increased risk of mortality. Early-stage patients with pathology diagnosis between 2016 and 2019 (odds ratio, 2.32; P = .043) versus before 2016 were more likely to experience delays ≥90 days, and late-stage patients who traveled >100 km to the treatment facility (odds ratio, 2.83; P < .001) versus <100 km were more likely to experience delays ≥120 days. CONCLUSIONS Delays in care are common in Botswana, particularly for those living farther from the treatment clinic and at advanced stages. This paper is among the first to show an association between treatment delays and worsened overall survival at advanced stages of cervical cancer, highlighting the need for interventions to help patients receive timely care in global settings.
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Affiliation(s)
- Jessica George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | - Shawna Tuli
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | - Palak P Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana; Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | - Peter Vuylsteke
- CHU Namur, Site Sainte-Elisabeth, UCLouvain, Namur, Belgium; Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Katharine A Rendle
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Family Medicine & Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Cavicchiolo ME, Brigiari G, Nosadini M, Pin JN, Vincenti A, Toldo I, Ancona C, Simioni P, D Errico I, Baraldi E, Sartori S. Cerebral venous thrombosis and deep medullary vein thrombosis: Padua experience over the last two decades. Eur J Pediatr 2024; 183:3461-3470. [PMID: 38780653 DOI: 10.1007/s00431-024-05602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT. MATERIALS AND METHODS Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol. RESULTS Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up. Conclusion: DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Gloria Brigiari
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Jacopo Norberto Pin
- Division of Neuropediatrics, Institute of Pediatrics of Southern Switzerland, Bellinzona, Switzerland
| | - Arianna Vincenti
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Claudio Ancona
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Ignazio D Errico
- Neuroradiology Unit, Department of Neuroscience, University Hospital of Padua, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
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Bhat A, Gulati A, Ryan WR, Chang JL. Comparison of Chronic Sialadenitis Symptom Burden in Patients With Sialolithiasis Versus Stenosis Before and After Sialendoscopy. Otolaryngol Head Neck Surg 2024; 171:418-424. [PMID: 38639292 DOI: 10.1002/ohn.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To define symptomatology and responses to treatment in chronic sialadenitis from sialolithiasis versus duct stenosis and establish a minimal clinically significant difference (MCID) in the validated Obstructive Salivary Problem Impact Test (SPIT). STUDY DESIGN Prospective, cohort. SETTING Tertiary-care center. METHODS Patients completed the SPIT questionnaire at presentation and 3 to 6 months after surgery. SPIT scores and domains were compared between patients with symptomatic sialolithiasis and those with stenosis of a major salivary gland. RESULTS Seventy-nine patients completed the SPIT, including 43 (54%) with sialolithiasis and 36 (46%) with stenosis. Stenosis patients displayed greater baseline scores compared to sialolithiasis patients (45.4 ± 19.9 vs 33.3 ± 18.5, P < .013). Frequency and severity of gland swelling and pain (21.9 ± 8.9 vs 17.1 ± 9.6, P = .02) and functional/psychosocial impact subscores were greater in the stenosis versus sialolithiasis groups (18.0 ± 10.9 vs 11.3 ± 9.4, P < .01). For 43 patients who underwent surgical intervention, SPIT scores improved at 3 to 6 months postoperatively in all domains (-18.6 ± 19.4, P < .01). Degree of improvement did not differ between sialolithiasis versus stenosis groups (-22.0 ± 20.9 vs -13.3 ± 15.8, P = .13). The MCID in SPIT score was found to be -13 points. A postoperative SPIT score of less than 10 suggested symptom resolution. CONCLUSION When compared to sialolithiasis, chronic salivary obstruction from stenosis is associated with greater baseline SPIT scores, indicating poorer sialadenitis-related quality of life due to greater symptom frequency and functional impact. Based on SPIT survey outcomes, a score decrease of 13 points or SPIT score <10 represent significant symptom improvement.
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Affiliation(s)
- Amrita Bhat
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Farley J, Taylor-Swanson L, Koppenhaver S, Thackeray A, Magel J, Fritz JM. The Effect of Combining Spinal Manipulation and Dry Needling in Individuals With Nonspecific Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104506. [PMID: 38484853 DOI: 10.1016/j.jpain.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of LBP. Spinal manipulative therapy (SMT), dry needling (DN), and exercise are common nonpharmacological treatments for LBP. This study is a 3-armed parallel-group design randomized clinical trial. We enrolled and randomized 96 participants with LBP into a multimodal strategy of treatment consisting of a combination of DN and SMT, DN only, and SMT only, followed by an at-home exercise program. All participants received 4 treatment sessions in the first 2 weeks followed by a 2-week home exercise program. Outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (lumbar multifidus, erector spinae, and gluteus medius muscle activation) measures at baseline, 2, and 4 weeks. Participants in the DN and SMT groups showed larger effects and statistically significant improvement in pain and disability scores, and muscle percent thickness change at 2 weeks and 4 weeks of treatment when compared to the other groups. This study was registered prior to participant enrollment. PERSPECTIVE: This article presents the process of developing an optimized multimodal treatment plan utilizing SMT, DN, and exercise to address the burden of LBP for impacted individuals and the health care system. This method could potentially help clinicians who treat LBP to lower initial pain and increase exercise compliance. (clinicaltrials.gov NCT05802901).
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Affiliation(s)
- Jedidiah Farley
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | | | | | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | - Jake Magel
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | - Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
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Briggs ES, Thomas RM, Frost MC, Fletcher OV, Crothers K, Chalal CK, Shahrir SF, McClure JB, Catz SL, Williams EC. "I Thought Cancer was a Tobacco Issue": Perspectives of Veterans with and without HIV on Cancer and Other Health Risks Associated with Alcohol and Tobacco/Nicotine Use. AIDS Behav 2024; 28:2607-2618. [PMID: 38869757 DOI: 10.1007/s10461-024-04363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
U.S. Veterans and people living with HIV (PWH) experience higher rates of unhealthy alcohol and tobacco/nicotine use than non-Veterans and people without HIV (PWoH). Both groups are susceptible to adverse health outcomes associated with alcohol and tobacco/nicotine use. We explored awareness of alcohol- and tobacco/nicotine-related cancer and immune health risks among Veterans Health Administration (VA) patients with and without HIV. Among a sample of 41 (46% PWH; 73% male; 39% Black) purposively-selected VA patients receiving care 2020-2021 we conducted semi-structured interviews via telephone; interviews were recorded, transcribed and analyzed using a Rapid Assessment Process. Purposive selection was based on HIV status, alcohol and/or tobacco/nicotine use, and demographics. Among participants, 66% reported current smoking, and most screened positive for unhealthy alcohol use. Participants had high awareness of cancer and other health risks related to smoking but low awareness of synergistic risks and cancer risks associated with alcohol use despite awareness of a range of other alcohol-related risks. Awareness of alcohol and/or tobacco/nicotine's impacts on the immune system was variable. Findings did not distinctly differ between PWH and PWoH. Low awareness of alcohol-related cancer risk, risks of co-occurring use, and varying awareness of the impacts of alcohol and tobacco/nicotine on the immune system suggest a need for improved messaging regarding substance use-related cancer and immune risk. This may be especially important among PWH, for whom the prevalence and adverse effects of alcohol and tobacco use, and immune dysfunction are higher.
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Affiliation(s)
- Elsa S Briggs
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA.
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
| | - Rachel M Thomas
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Madeline C Frost
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Olivia V Fletcher
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Kristina Crothers
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Clementine K Chalal
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Shahida F Shahrir
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Shah M, Jergel A, George RP, Jenkins E, Bashaw H. Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study. J Pediatr 2024; 271:114054. [PMID: 38615942 DOI: 10.1016/j.jpeds.2024.114054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), 2 conditions marked by episodes of nausea, vomiting, and abdominal pain. STUDY DESIGN We performed a retrospective chart review of patients admitted to a large children's health care system from 2015 through 2022. Patients with CHS and CVS were identified by the electronic medical record using International Classification of Diseases, Ninth and Tenth Revision codes. RESULTS Of 201 patients screened, 125 were included. Patients with CHS were older than those with CVS (mean [SD] 18.06 [1.41] vs 14.50 [2.91] years, P < .001). There were no significant differences in sex, race, ethnicity, or hospital length of stay between groups. Patients with CHS were more likely to have a positive urine drug screen (86% vs 2.9%, P < .001), lower mean (SD) serum potassium (3.62 [0.77] vs 3.88 [0.49], P < .001), and greater mean (SD) serum creatinine (0.83 (0.41) vs 0.63 (0.17), P < .001). The average (SD) systolic blood pressure was significantly greater in patients with CHS (systolic blood pressure 124.46 [10.66] vs 118.55 [10.99], P = .032) compared with children of comparable age range with CVS. Imaging was obtained in 36% of all patients, and only 2.4% had abnormalities. CONCLUSIONS Clinical features including older age, greater systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.
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Affiliation(s)
- Meera Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
| | - Andrew Jergel
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Roshan P George
- Division of Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Elan Jenkins
- Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatric Hospital Medicine, Emory University School of Medicine, Atlanta, GA
| | - Hillary Bashaw
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Worrall H, Podvin C, Althoff C, Chung JS, Sugimoto D, Stokes M, Radel LC, Cullum CM, Miller SM, Jones JC. Position comparison of sport-related concussions in female youth soccer players. PHYSICIAN SPORTSMED 2024; 52:325-332. [PMID: 37564006 DOI: 10.1080/00913847.2023.2246869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes. METHODS Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8-18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test. RESULTS Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%)At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions. CONCLUSION In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions.
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Affiliation(s)
- Hannah Worrall
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
| | - Caroline Podvin
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
| | - Claire Althoff
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
| | - Jane S Chung
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Mathew Stokes
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Luke C Radel
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | | | - Shane M Miller
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacob C Jones
- Department of Orthopedics and Sports Medicine, Scottish Rite for Children, Frisco, TX, USA
- UT Southwestern Medical Center, Dallas, TX, USA
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Condon EM, Scheibner HR, Kuzel M, Howard M, Cisse M, O'Connell M, Conley Y, Jeon S, Sadler LS, Redeker NS. The CARING study: Examining biological, behavioral, and genetic mechanisms in the intergenerational transmission of toxic stress. Res Nurs Health 2024; 47:369-383. [PMID: 38804202 PMCID: PMC11236528 DOI: 10.1002/nur.22400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
When children experience extreme or persistent stressors (e.g., maltreatment, housing insecurity, intimate partner violence), prolonged elevation of the stress-response system can lead to disrupted development of multiple physiological systems. This response, known as toxic stress, is associated with poor physical and mental health across the life course. Emerging evidence suggests that the effects of toxic stress may be transmitted through generations, but the biological and behavioral mechanisms that link caregivers' childhood history with the health of the children they care for remain poorly understood. The purpose of this report is to describe the research protocol for The CARING (Childhood Adversity and Resilience In the Next Generation) Study, a cross-sectional study of caregivers with children aged 3-5 years designed to (1) examine the intergenerational transmission of toxic stress and protective factors; (2) explore three hypothesized pathways of transmission: parenting, daily routines, stressors, and supports; and (3) explore the extent to which genotypic variation in candidate genes related to caregiving and stress contribute to caregivers' and children's susceptibility to the effects of early childhood experiences (i.e., gene × environment interactions). We expect that findings from this study will provide critical data needed to identify targets for precision health interventions, reduce health disparities related to toxic stress, and prevent cycles of adversity among families at risk.
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Affiliation(s)
- Eileen M Condon
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | | | - Meredith Kuzel
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Mackenzie Howard
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Mouhamadou Cisse
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Meghan O'Connell
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Yvette Conley
- University of Pittsburg School of Nursing, Pittsburg, Pennsylvania, USA
| | | | | | - Nancy S Redeker
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Hullenaar KL, Hicks CD, Stubblefield MW, Herndon L(F, Seabrooks SK, Vavilala MS, Laing SS. Insights from Developing and Implementing a Novel School Community Collaborative Model to Promote School Safety. THE JOURNAL OF SCHOOL HEALTH 2024; 94:768-776. [PMID: 38637288 PMCID: PMC11230839 DOI: 10.1111/josh.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND School Resource Officer (SRO) programs do not reduce school violence and increase school discipline. We describe the use of a culturally responsive framework to form a school community collaborative among students, parents, staff, administrators, and law enforcement to reform an SRO program, promote school safety, and reduce punitive measures. METHODS Members of a participating school district, a local county, and a university collaborated. Adapting an identified culturally responsive model, a racially/ethnically diverse school community co-developed and implemented a School Community Collaborative (SCC) to address a school safety priority (SRO program reform). The main outcomes were SCC model development and implementation, policy change, and school community feedback. RESULTS Sixteen community members participated in the 5-week SCC with students, staff, law enforcement, and parents. The SCC revised the district's SRO memorandum of understanding (MOU) with law enforcement. Participants reported favorable feedback, and 89% reported the inclusion of diverse voices. CONCLUSIONS Co-development and implementation of an SCC process with schools were feasible. School SCC participated in a community-engaged evaluation and revision of an MOU.
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Affiliation(s)
- Keith L. Hullenaar
- Department of Epidemiology, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Chelsea D. Hicks
- Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Marcus W. Stubblefield
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
- King County, Seattle, WA
| | | | - Susan K. Seabrooks
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
- Department of Anesthesiology and Pediatrics, University of Washington, Seattle, WA
| | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
- Department of Anesthesiology and Pediatrics, University of Washington, Seattle, WA
| | - Sharon S. Laing
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
- School of Nursing and Healthcare Leadership, University of Washington, Tacoma, WA
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Guss CE, DeMaio D, Gluskin B, Daddario S, Addison J, Fitzgerald S, Mayer KH, Wisk LE, Krakower D. Pediatrician Preferences for Electronic Clinical Decision Support to Facilitate HIV Pre-Exposure Prophylaxis. J Adolesc Health 2024; 75:368-371. [PMID: 38852087 PMCID: PMC11257793 DOI: 10.1016/j.jadohealth.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Pediatric primary care clinicians are often uncertain about patients' HIV infection risk and pre-exposure prophylaxis (PrEP) prescribing guidelines. This study was conducted to help identify ways to design and deliver useful electronic health record (EHR)-based alerts for PrEP to help mitigate this issue. METHODS Individual interviews and focus groups with pediatricians explored provider preferences for clinical decision support around PrEP in the EHR. Key themes were identified via the immersion-crystallization qualitative analytic technique. RESULTS Clinicians described ideal decision support tools as succinct, helpful in identifying patients at risk of acquiring HIV, providing automated follow-up, and linking to evidence-based prescribing guidelines. Concerns emerged about alert fatigue. DISCUSSION This study summarizes clinicians' preferences for EHR tool development to support PrEP provision among pediatricians with limited comfort and experience with prescribing PrEP. These findings can inform the development of PrEP decision support by implementing provider-centered feedback.
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Affiliation(s)
- Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Danielle DeMaio
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Brittany Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica Addison
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts
| | - Susan Fitzgerald
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kenneth H Mayer
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Douglas Krakower
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Magrum B, Elefritz JL, Eisinger G, McLaughlin E, Doepker B. Efficacy of Continuous Infusion Ketamine for Analgosedation in the Medical Intensive Care Unit: A Propensity-Weighted Analysis. J Pharm Pract 2024; 37:862-870. [PMID: 37480556 DOI: 10.1177/08971900231191154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background: Few randomized controlled trials have evaluated the use of ketamine vs opiate-based analgosedation. Methods: A retrospective cohort analysis of 169 mechanically ventilated patients admitted to the medical intensive care unit (MICU) at an academic medical center was conducted to evaluate efficacy of ketamine vs opiate-based analgosedation by comparing the percentage of time within target sedation range. The primary outcome was percentage of time within target sedation range (RASS -1 to +1) within first 72 hours of primary sedation initiation. Secondary outcomes including percentage of time under-sedated, over-sedated, and in coma; use of concomitant analgesic, sedative, and antipsychotic agents; presence of delirium; percentage of CPOT scores at goal; and hemodynamic effects were also evaluated. Results: After weighting, the mean percentage of time at RASS goal for ketamine patients was 43.0% compared to 41.4% for opiate-based sedation patients. Ketamine was not significantly non-inferior to opiate-based sedation for the mean percentage of time at RASS goal (P = .11). The median percentage of CPOT scores at goal was 13.3% higher in the ketamine group (P = .042). Patients in the ketamine group received significantly less additional sedative agents than the patients in the opiate-based sedation group. Conclusion: A similar percent of time at RASS goal was found for the ketamine analgosedation group compared to the opiate-based sedation group, although this did not reach statistical signicance for non-inferiority due to lack of statistical power. This study found a higher percentage of CPOT scores within goal with less additional sedative agents required compared to an opiate-based sedation regimen.
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Affiliation(s)
- BrookeAnne Magrum
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jessica L Elefritz
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Greg Eisinger
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric McLaughlin
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Bruce Doepker
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Navuluri N, Kussin PS, Egger JR, Birgen E, Kitur S, Thielman NM, Parish A, Green CL, Janko MM, Diero L, Wools-Kaloustian K, Lagat D, Que LG. Tuberculosis Is Associated with Chronic Hypoxemia among Kenyan Adults (CHAKA): A Case-Control Study. Ann Am Thorac Soc 2024; 21:1176-1185. [PMID: 38761372 DOI: 10.1513/annalsats.202402-167oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
Rationale: Data on risk factors for chronic hypoxemia in low- and middle-income countries are lacking. Objectives: We aimed to quantify the association between potential risk factors and chronic hypoxemia among adults hospitalized in Kenya. Methods: A hospital-based, case-control study was conducted at Moi Teaching and Referral Hospital in Eldoret, Kenya. Adult inpatients were screened on admission and enrolled in a 1:2 case-to-control ratio. Cases were patients with chronic hypoxemia, defined as resting oxygen saturation as measured by pulse oximetry (SpO2) ⩽ 88% on admission and either 1-month postdischarge SpO2 ⩽ 88% or, if they died before follow-up, documented SpO2 ⩽ 88% in the 6 months before enrollment. Control subjects were randomly selected, stratified by sex, among nonhypoxemic inpatients. Data were collected using questionnaires and structured chart review. Regression was used to assess the associations between chronic hypoxemia and age, sex, smoking status, biomass fuel use, elevation, and self-reported history of tuberculosis and human immunodeficiency virus diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results: We enrolled 108 chronically hypoxemic cases and 240 nonhypoxemic control subjects into our Chronic Hypoxemia among Kenyan Adults (CHAKA) cohort. In multivariable analysis, compared with control subjects, chronically hypoxemic cases had significantly higher odds of older age (OR, 1.2 per 5-year increase [95% CI, 1.1-1.3]), female sex (OR, 3.6 [95% CI, 1.8-7.2]), current or former tobacco use (OR, 4.7 [95% CI, 2.3-9.6]), and prior tuberculosis (OR, 11.8 [95% CI, 4.7-29.6]) but no increase in the odds of human immunodeficiency virus diagnosis and biomass fuel use. Conclusions: These findings highlight the potential impact of prior tuberculosis on chronic lung disease in Kenya and the need for further studies on posttuberculosis lung disease.
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Affiliation(s)
- Neelima Navuluri
- Department of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Peter S Kussin
- Department of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Elcy Birgen
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sylvia Kitur
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Nathan M Thielman
- Department of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, School of Medicine, and
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, School of Medicine, and
| | - Mark M Janko
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Lameck Diero
- Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya; and
| | - Kara Wools-Kaloustian
- Division of Infectious Disease, Department of Medicine, School of Medicine, University of Indiana, Indianapolis, Indiana
| | - David Lagat
- Moi University School of Medicine and Moi Teaching and Referral Hospital, Eldoret, Kenya; and
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Asada T, Simon CZ, Singh N, Tuma O, Subramanian T, Araghi K, Lu AZ, Mai E, Kim YE, Allen MRJ, Korsun M, Zhang J, Kwas C, Singh S, Dowdell J, Sheha ED, Qureshi SA, Iyer S. Limited Improvement With Minimally Invasive Lumbar Decompression Alone for Degenerative Scoliosis With Cobb Angle Over 20°: The Impact of Decompression Location. Spine (Phila Pa 1976) 2024; 49:1037-1045. [PMID: 38375684 DOI: 10.1097/brs.0000000000004968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multisurgeon registry. OBJECTIVE To evaluate the outcomes of minimally invasive (MI) decompression in patients with severe degenerative scoliosis (DS) and identify factors associated with poorer outcomes. SUMMARY OF BACKGROUND CONTEXT MI decompression has gained widespread acceptance as a treatment option for patients with lumbar canal stenosis and DS. However, there is a lack of research regarding the clinical outcomes and the impact of MI decompression location in patients with severe DS exhibiting a Cobb angle exceeding 20°. MATERIALS AND METHODS Patients who underwent MI decompression alone were included and categorized into the DS or control groups based on Cobb angle (>20°). Decompression location was labeled as "scoliosis-related" when the decompression levels were across or between end vertebrae and "outside" when the operative levels did not include the end vertebrae. The outcomes, including the Oswestry Disability Index (ODI), were compared between the propensity score-matched groups for improvement and minimal clinical importance difference (MCID) achievement at ≥1 year postoperatively. Multivariable regression analysis was conducted to identify factors contributing to the nonachievement of MCID in ODI of the DS group at the ≥1-year time point. RESULTS A total of 253 patients (41 DS) were included in the study. Following matching for age, sex, osteoporosis status, psoas muscle area, and preoperative ODI, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs. control 69.0%, P =0.047). The "scoliosis-related" decompression (odds ratio: 9.9, P =0.028) was an independent factor of nonachievement of MCID in ODI within the DS group. CONCLUSIONS In patients with a Cobb angle >20°, lumbar decompression surgery, even in the MI approach, may result in limited improvement of disability and physical function. Caution should be exercised when determining a surgical plan, especially when decompression involves the level between or across the end vertebrae. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tomoyuki Asada
- Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, University of Tsukuba, Institute of Medicine, Tsukuba, Japan
| | | | | | | | - Tejas Subramanian
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | - Amy Z Lu
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Eric Mai
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Yeo Eun Kim
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | - Cole Kwas
- Hospital for Special Surgery, New York, NY
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50
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Nielsen AH, Kaldan G, Gade LM, Egerod I. Postextubation dysphagia management in Danish intensive care units: A national survey. Acta Anaesthesiol Scand 2024; 68:949-955. [PMID: 38719567 DOI: 10.1111/aas.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. METHODS Self-reported, cross-sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. RESULTS Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio-oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under-recognition of dysphagia as a health issue, and lack of standardized protocols. CONCLUSION Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Gudrun Kaldan
- Research Unit 98A52, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen O, Denmark
| | - Lotte Madsen Gade
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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